M.A. and Department of Defense, Defense Logistics Agency (Board decision, May 2, 2025)

ECAB remand decision. The Board reversed OWCP's denial of compensation for specified medical appointment time and returned the case to authorize payment; the amount to be paid remains for OWCP to administer. A party may petition the Board for reconsideration within 30 days of issuance unless this order specifies another period, under 20 C.F.R. § 501.7(a). FECA compensation decisions are generally not subject to court review under 5 U.S.C. § 8128(b).

Plain-English summary

A Defense Logistics Agency worker sought wage-loss compensation for time away from work to attend treatment for an accepted injury. The Board found the record established authorized appointments on multiple dates from December 2020 through March 2021. It ordered OWCP to pay up to four hours for each qualifying appointment and set aside a later decision as moot.

Decision snapshot

• Authority: Federal Employees' Compensation Act, 5 U.S.C. § 8101 et seq.
• Outcome: Appointment-time compensation established; case remanded for payment.
• Key point: Authorized treatment appointments supported wage-loss compensation for time away from work.

Full text (ECAB public release)

United States Department of Labor
Employees’ Compensation Appeals Board

_______
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M.A., Appellant
)
)
and ) Docket No. 22-0328
)
Issued: May 2, 2025
DEPARTMENT OF DEFENSE, DEFENSE
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LOGISTICS AGENCY, Barstow, CA,
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Employer
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_________ )

Appearances: Case Submitted on the Record
Appellant, pro se
Office of Solicitor, for the Director

DECISION AND ORDER

Before:
ALEC J. KOROMILAS, Chief Judge
PATRICIA H. FITZGERALD, Deputy Chief Judge JANICE B. ASKIN, Judge

JURISDICTION

On December 27, 2021 appellant filed a timely appeal from a July 29, 2021 merit decision and a December 1, 2021 nonmerit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the Federal Employees’ Compensation Act1 (FECA) and 20 C.F.R.
§§ 501.2(c) and 501.3, the Board has jurisdiction over the merits of this case. 2

ISSUES

The issues are: (1) whether appellant has met her burden of proof to establish compensation for time lost from work to attend medical appointments on intermittent dates during the period December 21, 2020 through March 31, 2021, causally related to her accepted July 16,

1
5 U.S.C. § 8101 et seq.
2
The Board notes that, following the issuance of the December 1, 2021 decision, OWCP received additional evidence. However, the Board’s Rules of Procedure provides: “The Board’s review of a case is limited to the evidence in the case record that was before OWCP at the time of its final decision. Evidence not before OWCP will not be considered by the Board for the first time on appeal.” 20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from reviewing this additional evidence for the first time on appeal. Id. 2020 employment injury; and (2) whether OWCP properly denied her request for reconsideration of the merits of her claim, pursuant to 5 U.S.C. § 8128(a).

FACTUAL HISTORY

On July 17, 2020 appellant, then a 35-year-old distribution process worker, filed a traumatic injury claim (Form CA-1) alleging that on July 16, 2020 she injured her right shoulder when she picked up a box, her right shoulder popped, and she sustained shooting pain down her right arm, while in the performance of duty. She did not stop work, but returned to light duty. OWCP accepted the claim for right shoulder impingement syndrome.

Dr. Rama Pathia, a Board-certified orthopedic surgeon and treating physician, initially examined appellant on August 12, 2020. He diagnosed impingement syndrome of the right shoulder and cervicalgia, for which he restricted appellant to light duty. Dr. Pathia treated appellant again on September 11, October 16, and November 9, 2020; and continued to restrict appellant to light duty. He noted appellant’s restrictions of no overhead reaching or pulling and avoid repetitive use of right shoulder. In each report, Dr. Pathia also recommended physical therapy, three times a week, for four weeks.

In a December 7, 2020 report, Dr. Pathia related that appellant had continued pain in the right shoulder and the right middle and ring finger, but that her pain improved with the use of a sling. He noted that she had a history of a C2 and C5 fracture 15 years prior and reported no prior industrial or nonindustrial injuries to the right shoulder. Dr. Pathia diagnosed pain in the right shoulder, impingement syndrome of the right shoulder, and arthritis of the right shoulder region. He recommended physical therapy three times per week for four weeks and light duty until appellant’s next appointment scheduled on January 4, 2021.

OWCP received physical therapy notes dated from October 14 through December 4, 2020.
These notes indicated that appellant received continued therapy for right shoulder impingement syndrome.

Dr. Pathia treated appellant on February 1 and March 29, 2021 and diagnosed impingement syndrome of right shoulder. In his February 1, 2021 report, he recommended continued physical therapy for four weeks.

On April 3, 2021 appellant filed claims for compensation (Form CA-7) for intermittent disability from work during the period October 26, 2020 through March 31, 2021. In accompanying time analysis forms (Form CA-7a), she claimed 138 hours of leave without pay (LWOP) to include: two hours for physical therapy on November 16; four hours for physical therapy on November 2, 4, 12, 13, 23, and 25, and December 2, 2020; four hours for a doctor’s appointment on November 9, 2020; four hours for x-ray on December 3, 2020; and four hours for physical therapy on December 4, 2020; four hours for a doctor’s visit on December 7, 2020; four hours for physical therapy on December 21, 23, 30, and 31, 2020, and January 21, 22, 27, and 29, 2021; four hours for a doctor’s visit on February 1, 2021; and four hours for physical therapy on February 3, 2021; four hours of physical therapy on February 5, 10, 12, and 19, 2021; four hours doctor’s visit on March 1, 2021; and four hours for physical therapy on March 10, 12, 17, 19, 24, and 26, 2021; four hours for a doctor’s visit on March 29, 2021, and four hours for physical therapy on March 31, 2021.

2
By development letter dated April 8, 2021, OWCP noted it had received appellant’s Form CA-7 claims for compensation for time lost from work to attend medical appointments during the period November 2, 2020 through March 31, 2021. It explained that her claims were not payable in their entirety, but authorized payment for a total of 50 hours of LWOP for November 2, 4, 9, 12, 13, 16, 23, and 25, and December 2, 4, and 7, 2020, and February 1 and March 29, 2021. OWCP informed appellant that the evidence of record was insufficient to establish her claims for a total of 88 hours of LWOP for December 3, 21, 23, 30, and 31, 2020; and January 21, 22, 27, and 29, February 3, 5, 10, 12, and 19, and March 1, 10, 12, 17, 19, 24, 26, and 31, 2021. It advised her of the type of medical evidence needed to establish her claims and afforded her 30 days to submit the necessary evidence.

OWCP continued to receive progress reports from Dr. Pathia dated April 28, 2021. In his April 28, 2021 report, Dr. Pathia recommended continued physical therapy, three times a week.

By decision dated June 25, 2021, OWCP denied appellant’s claim for compensation for a total of 88 hours of LWOP for December 3, 21, 23, 30, and 31, 2020; and January 21, 22, 27, and 29, February 3, 5, 10, 12, and 19, and March 1, 10, 12, 17, 19, 24, 26, and 31, 2021. It found that the medical evidence of record was insufficient to establish that she attended medical appointments on those dates.

On July 7, 2021 appellant requested reconsideration and submitted additional evidence, including December 3, 2020 and April 21 and July 19, 2021 x-ray and magnetic resonance imaging (MRI) scan reports of appellant’s right shoulder, and a July 23, 2021 note from Dr. Pathia advising appellant to stay off work until her August 23, 2021 scheduled appointment.

The case record also contains OWCP-generated claimant bill inquiry lists, which note appellant’s medical appointments from July 28, 2020 through March 31, 2021. These documents listed the dates of the billed appointments, the amounts charged and paid, and the providers’ names. OWCP verified payment for medical treatment with Dr. Pathi received on the following dates December 21, 23, and 31, 2020; January 21, 22, 27, and 29, 2021; February 3, 5, 10,12, and 19, 2021; and March 1, 10, 19, 24, 26, and 31, 2021.

The case record also contains a June 23, 2021 patient encounter summary, which noted dates of medical treatment for appellant’s right shoulder during the period July 28, 2020 through July 16, 2021. This included encounters on December 30, 2020 and March 12 and 17, 2021.

OWCP also received a provider authorization list, which noted authorization for physical therapy by Dr. Pathi, and an authorization utilization list.

By decision dated July 29, 2021, OWCP modified the June 25, 2021 decision to authorize payment of compensation for four hours of LWOP on December 3, 2020 for an x-ray appointment. The claim remained denied, however, as the evidence of record was insufficient to establish that appellant attended medical appointments for treatment of her accepted conditions on the remaining dates.

On September 2, 2021 appellant requested reconsideration.

OWCP received an updated patient encounter summary, which noted dates of medical treatment for appellant’s right shoulder during the period July 28, 2020 through August 23, 2021.

3
By decision dated December 1, 2021, OWCP denied appellant’s request for reconsideration of the merits of her claim, pursuant to 5 U.S.C. § 8128(a).

LEGAL PRECEDENT -- ISSUE 1

An employee seeking benefits under FECA has the burden of proof to establish the essential elements of his or her claim by the preponderance of the evidence. 3 For each period of disability claimed, the employee has the burden of proof to establish that he or she was disabled from work as a result of the accepted employment injury. 4 Whether a particular injury causes an employee to become disabled from work, and the duration of that disability, are medical issues that must be proven by a preponderance of probative and reliable medical opinion evidence. 5

Under FECA the term “disability” means the incapacity, because of an employment injury, to earn the wages that the employee was receiving at the time of injury. 6 The Board will not require OWCP to pay compensation for disability in the absence of medical evidence directly addressing the specific dates of disability for which compensation is claimed. To do so, would essentially allow an employee to self-certify their disability and entitlement to compensation. 7

The Board has interpreted section 8103, which requires payment of expenses incidental to the securing of medical services, as authorizing payment for loss of wages incurred while obtaining medical services. 8 An employee is entitled to disability compensation for any loss of wages incurred during the time he or she receives authorized treatment and for loss of wages for time spent, incidental to such treatment. The rationale for this entitlement is that, during such required examinations and treatment and during the time incidental to undergoing such treatment, an employee did not receive his or her regular pay. For a routine medical appointment, a maximum of four hours of compensation for time lost to obtain medical treatment is usually allowed. 9

ANALYSIS -- ISSUE 1

The Board finds that appellant has met her burden of proof to establish compensation for time lost from work to attend medical appointments on December 21, 23, 30, and 31, 2020;

3
See B.O., Docket No. 19-0392 (issued July 12, 2019); D.W., Docket No. 18-0644 (issued November 15, 2018).
4
Id.
5
20 C.F.R. § 10.5(f); B.O., supra note 3; N.M., Docket No. 18-0939 (issued December 6, 2018).
6
Id. at § 10.5(f); see B.K., Docket No. 18-0386 (issued September 14, 2018).
7
A.W., Docket No. 18-0589 (issued May 14, 2019).
8
J.E., Docket No. 19-1758 (issued March 16, 2021); Y.H., Docket No. 17-1303 (issued March 13, 2018).
9
For a routine medical appointment, a maximum of four hours of compensation for time lost to obtain medical treatment is usually allowed. See Federal (FECA) Procedure Manual, Part 2 -- Claims, Compensation Claims, Chapter 2.901.19 (February 2013); R.S., 23-1081(issued April 3, 2024); J.E., id., see also K.A., Docket No. 19-0679 (issued April 6, 2020).

4
January 21, 22, 27, and 29, 2021; February 3, 5, 10, 12, and 19, 2021; and March 1, 10, 12, 17, 19, 24, 26, and 31, 2021, causally related to her accepted July 16, 2020 employment injury.

The case record includes OWCP-generated claimant bill inquiry lists, which note appellant’s medical appointments from July 28, 2020 through March 31, 2021. These documents, verified that OWCP authorized payment for appellant’s medical treatment with Dr. Pathi on the following dates: December 21, 23, and 31, 2020; January 21, 22, 27, and 29, 2021; February 3, 5, 10, 12, and 19, 2021; and March 1, 10, 19, 24, 26, and 31, 2021. Accordingly, the Board finds that appellant is entitled to up to four hours of compensation for time lost from work to attend medical appointments on those dates, causally related to her accepted July 16, 2020 employment injury.

The case record also contains a June 23, 2021 patient encounter summary, which noted dates of medical treatment for appellant’s right shoulder during the period July 28, 2020 through July 16, 2021. This included encounters on December 30, 2020 and March 12 and 17, 2021. Accordingly, the Board also finds that appellant is entitled to up to four hours of compensation for attending physical therapy appointments on those dates as well.

As the evidence of record is sufficient to establish compensation for time lost from work to attend medical appointments on December 21, 23, 30, 31, 2020; January 21, 22, 27, and 29, 2021; February 3, 5, 10, 12, and 19, 2021; and March 1, 10, 12, 17, 19, 24, 26, and 31, 2021, causally related to her accepted July 16, 2020 employment injury, the Board finds that appellant has met her burden of proof.

On remand, OWCP shall authorize wage-loss compensation consistent with this decision of the Board. 10

CONCLUSION

The Board finds that appellant has met her burden of proof to establish compensation for time lost from work to attend medical appointments on December 21, 23, 30, and 31, 2020; January 21, 22, 27, and 29, 2021; February 3, 5, 10, 12, and 19, 2021; and March 1, 10, 12, 17, 19, 24, 26, and 31, 2021, causally related to her accepted July 16, 2020 employment injury.

10
In light of the Board’s disposition of Issue 1, Issue 2 is rendered moot.

5
ORDER

IT IS HEREBY ORDERED THAT the July 29, 2021 decision of the Office of Workers’ Compensation Programs is reversed and the case is remanded for further proceedings consistent with this decision of the Board. The December 1, 2021 decision of the Office of Workers’ Compensation Programs is set aside as moot.

Issued: May 2, 2025
Washington, DC

Alec J. Koromilas, Chief Judge
Employees' Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge Employees' Compensation Appeals Board

Janice B. Askin, Judge
Employees' Compensation Appeals Board

6